<?php include "menu.phtml"; $service_name = ucfirst($this->attributes['name']->getAttributeEntity()->getValue()); ?>
<div id="right">
	<div class="rightbox">
		<div class="context"><div class="in"><a href="javascript:void(0);" id="context_menu" class="icon_link the_down"><span></span></a></div></div>
		<h1><?php echo $this->translate->_("Request Membership"); ?></h1>
		<br />
		<div>
			<label for="captcha_picture"><?php echo $this->translate->_("Service")?></label>
			<input type="text"  value="<?php echo $service_name; ?>" disabled="disabled" style="background: none; border: none; padding: 6px 0px 4px;">
			<div class="cls"></div>
		</div>
		<?php echo $this->form; ?>
	</div>
</div>